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General NPI Number Information
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NPI Number | 1528604758
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Entity Type | Individual
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Provider Name | NICHOLAS BROWN DYCHES NRP, FP-C, SO-ATP
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Gender | Male
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Dates
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Enumeration Date | 11/22/2019
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Last Update Date | 11/22/2019
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Provider Practice Location Address
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Address Line | 4700 LAS VEGAS BLVD N BLDG 1300
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City | LAS VEGAS
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State | NV
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Zip | 89191-6600
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Country | US
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Telephone | 702-228-5643
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Fax |
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Provider Business Mailing Address
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Address Line | 1421 AIRPORT RD STE 100
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City | BOULDER CITY
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State | NV
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Zip | 89005-3659
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Country | US
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Telephone | 702-228-5643
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1710I1003X
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Taxonomy Name | Independent Duty Medical Technicians
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License Number |
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License Number State |
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